We're about to Make Sex Better for 66% of Women: Find Out What to Do When Sex Hurts

Not all OB-GYNS feel comfortable asking patients how their sex lives are, but I do it all the time. Of course I want to know about any new partners because of STD risk, and find out if you're happy with your birth control—but I can also learn a lot about your health from how much you're actually enjoying sex. I can't tell you how many times a patient has started off saying, "Oh, everything's fine, thanks…," but ended up confessing that sex hasn't been just so-so—it hurts. Some have said it feels like "one big period cramp" or even like "he's splitting me in half." I wish this were rare, but the American College of Obstetricians and Gynecologists estimates that two thirds of women will have painful sex at some point in their lives. Women often suffer in silence because they're too embarrassed to speak up, or because they assume there's no remedy. But the truth is, if sex hurts, it's usually pretty easy to find out why and, in most cases, to fix it. So I ask my patients these questions to get to the bottom of what's going on—and get them back in the sack.

Q: In certain positions, or always?

You may need more foreplay or have vaginal dryness.

Simply not being lubricated enough is the number-one reason for pain during sex. There are two parts to our body's response to foreplay. The first is engorgement, a rushing of blood to the vagina that expands the vaginal walls—our version of an erection. The second is lubrication, a release of moisture from the glands that ring the vaginal opening. Both actions signal your readiness for sex, so starting before they take place can hurt. One patient told me, "A little friction feels good, but I think there's too much friction happening." The quick fix? Lubricant like Astroglide or K-Y. A better fix? More foreplay. If you've been taking an anti-allergy medication, that could be the culprit—antihistamines are one of several medications that can lead to dryness (others include antidepressants and, although it's not common, the Pill). Talk to your doctor about it, or keep a water-based lube on hand.

It may be vulvodynia or herpes.

The word basically means "painful vulva." It's a condition up to 16 percent of women have, but we still don't understand very well what causes it. Women often describe it as a burning, stinging, itching, irritating or raw feeling on their vulva and labia, and say it sometimes hurts even when they're just sitting or walking around. If this sounds like you, get a referral to a vulvar-pain specialist (your doctor can find one at nva.org) or talk to your ob-gyn. Topical creams and oral medications (including antidepressants) have helped dozens of my patients. The other possibility here is genital herpes. Take a mirror and look for pimplelike bumps that look like clear blisters on a red base. If you see anything suspicious, don't google herpes pictures (it will just freak you out); head to your gynecologist.

You may have a yeast infection.

The dreaded overgrowth of the microscopic fungal candida often makes the vulva, vagina and cervix become irritated, inflamed and incredibly sensitive. (One of my patients told me sex during a yeast infection felt like her partner was "wearing a sandpaper condom.") If you're tender and itchy, and have clumpy discharge, an over-the-counter vaginal yeast infection treatment should fix you up within a few days to a week. If it doesn't, see your gynecologist to rule out STDs and other infections like bacterial vaginosis (BV).

He may be bumping your cervix.

It may sound strange, but getting your cervix bumped can hurt. About 20 percent of women have a retroverted uterus (meaning the organ tips back toward the tailbone, instead of forward toward the bladder), which makes it easy for the penis to brush up against your cervix. But the mishap can happen to any woman during sex positions with deeper penetration, like doggy style. So if it "feels like he's pushing my uterus up into my stomach," as one patient told me, try woman-on-top, where you can control how deeply, and quickly, your partner thrusts.

It may be an ovarian cyst or UTI.

If the pain is on only one side, you could have an ovarian cyst. Your ovaries make cysts for a living; each month a little one forms around the developing egg, then bursts to release it during ovulation. But if the cyst isn't quickly reabsorbed like normal, it can swell up with fluid or blood and get very uncomfortable, especially during sex. Most cysts will go away within a few weeks or months on their own, but in rare cases, persistent cysts may need surgery. Ask your ob-gyn for an ultrasound to check your ovaries. Ibuprofen can ease the pain, and hormonal birth control can ward off cysts in the future. If it hurts more in the middle of your pelvis—especially if you've noticed that it burns when you pee or you have to go a lot—it could be a urinary tract infection (UTI), and you should see your doctor for antibiotics. (No, cranberry juice won't cure it.)

You may have endometriosis, PID or interstitial cystitis.

This is a condition in which tissue that looks and acts like the lining of the uterus grows outside of it—on the ovaries, fallopian tubes or even the abdominal wall. Aside from uncomfortable sex, it can also cause constant pelvic pain and excruciating periods. The Pill, or other hormonal birth control, is the best treatment. Another possible culprit for your discomfort is pelvic inflammatory disease (PID), which usually results from an untreated infection like chlamydia or gonorrhea traveling into your uterus and fallopian tubes. (Until reaching this advanced stage, STDs aside from herpes almost never cause painful sex on their own.) Other symptoms of PID may be stomach pain, fever and smelly discharge. Sound like you? Get to your doctor ASAP—PID is usually curable with a simple two-week course of antibiotics, but it can harm your fertility if you don't take care of it. The third possible cause for your pain is interstitial cystitis (IC), an inflammation of the bladder that causes a stinging sensation when you pee, and a frequent, urgent need to go. It's often misdiagnosed as chronic UTI because of the similar symptoms. If you're visiting the restroom hourly and are hurting during or after sex, see your doctor for an evaluation and ask about IC.

It may be pelvic congestion

No, this doesn't mean your vagina has a cold. During foreplay and arousal, blood rushes to the pelvis; after sex, the muscles and blood vessels relax, allowing the blood to reenter the rest of the body. But if the muscles don't unclench and the blood doesn't dissipate, it can cause a dull pain. It's not dangerous, but it can be uncomfortable. The best remedy for what I call "blue walls" (a little like guys' blue balls) is, of course, orgasm. And if that doesn't relieve your discomfort, consider "premedicating" before sex with 600 to 800 milligrams of ibuprofen to treat the pain.